National Cervical Screening Program Renewal
The National Cervical Screening Program (NCSP) Renewal aims to ensure the success of the program continues and all Australian women, human papillomavirus (HPV) vaccinated and unvaccinated, have access to a cervical screening program that is based on current evidence and best practice. The Renewal will play a pivotal role in reviewing the science and technologies related to the NCSP to ensure its success continues into the future.
See below for more information on:
What is the Renewal?
What are the objectives of the Renewal?
Why is the Renewal being conducted?
Who will be involved in the Renewal?
How will the Renewal be undertaken?
What has been achieved to date?
When will the Renewal be completed?
Frequently Asked Questions
What is the Renewal?The NCSP, for the past 20 years, offered routine screening with Pap smears every two years for women between the ages of 18 and 70 years. The NCSP is jointly funded by the Australian, state and territory governments. Since its introduction, the incidence of cervical cancer and the death rate from cervical cancer have both decreased by approximately 50 per cent.
The Renewal will review the science and technologies related to the program to ensure that all Australian women have access to a cervical screening program that is based on the best available evidence and promotes best clinical practice. The renewed program will aim to continue to improve health outcomes of Australian women.
Further information about the current NCSP is available on the Cancer Screening website.
Information about the performance of the NCSP is published each year by the Australian Institute of Health and Welfare (AIHW). The latest report, Cervical Screening in Australia 2009-2010 is available on the AIHW website.
What are the objectives of the Renewal?The objectives of the Renewal are to:
- assess the evidence for screening tests and pathways, the screening interval, age range and commencement for both vaccinated and non-vaccinated women;/li>
- determine a cost-effective screening pathway and program model;
- investigate options for improved national data collection systems and registry functions to enable policy, planning, service delivery and quality management; and
- assess the feasibility and acceptability of the renewed program for women.
Why is this Renewal being conducted?The science of cancer is one of the most rapidly changing areas in health and while the success of the NCSP cannot be disputed, the environment in which the program operates has changed. Since the introduction of the NCSP in 1991, there is a greater depth of knowledge and understanding about the natural progression of cervical abnormalities and the development of cervical cancer.
Evidence about the screening age range and interval has changed over time and there are new tests for the early detection of pre-cancerous cervical changes. Furthermore, young Australian women are now provided the opportunity to be vaccinated against HPV, which prevents some HPV infections that can lead to cervical cancer.
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The NCSP also needs to reach under-screened women to further reduce deaths from cervical cancer in Australia.
In 2004, the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO), recommended that the cervical screening age range should be 25 to 65 years of age, and that the interval should be every three years up to the age of 49 and five yearly up to 65 years of age.
The National Health and Medical Research Council (NHMRC) has recommended a review of the cervical screening interval in Australia, as part of its approval of the 2005 Guidelines for the management of asymptomatic women with screen detected abnormalities.
Who will be involved in the Renewal?The Renewal Steering Committee will guide the Renewal process, supported by the Australian Government’s Department of Health. It comprises cervical screening experts in the fields of gynaecological oncology, pathology, cytology, epidemiology, general practice and nursing as well as Commonwealth and state and territory government representatives and a consumer advocate.
The Committee will actively consult with and seek input from a wide range of NCSP partners, including health professionals, scientists and consumers, through a Partner Reference Group.
Four Partner Reference Group workshops were held on 27 and 29 March 2012. If you would like to join the Partner Reference Group contact the Renewal, email the Renewal Team.
How will the Renewal be undertaken?The Renewal will consist of two phases in line with the objectives outlined above.The first phase is linked to objectives one and two, and the second phase is linked to objectives three and four. The first phase of the Renewal is being undertaken through the Medical Services Advisory Committee (MSAC) review process. Further detail on MSAC and each phase is provided below.
Medical Services Advisory Committee (MSAC)The Medical Services Advisory Committee (MSAC) advises the Australian Minister for Health on evidence relating to the safety, effectiveness and cost-effectiveness of new medical technologies and procedures. The first phase of the Renewal is being undertaken through the MSAC process for reviewing new technologies and procedures for public funding.
Decision Analytic ProtocolIn line MSAC processes, a decision analytic protocol (DAP) has been developed to guide the comparative analysis of the evidence and the value for money assessment (economic evaluation). After a public consultation process the DAP was finalised in September 2012. More information on the DAP.
Comparative analysis of the evidence for cervical screeningsThe comparative analysis will examine the current evidence about:
- international cervical screening policy, programs and their screening coverage and population outcomes;
- cervical screening age ranges, intervals, and primary screening and triage pathways for vaccinated and unvaccinated women;
- the comparative safety and effectiveness of liquid based cytology, HPV DNA tests and Pap tests in primary screening and triage pathways;
- the expected impact of HPV vaccination on cervical abnormalities detected within a national cervical screening program.
Value for MoneyFollowing the comparative analysis of the evidence, the possible screening pathways will be subjected to an economic evaluation. This evaluation will allow an economic comparison of selected cervical screening pathways and may include a component that adjusts for the impact of the National HPV Vaccination Program.
The anticipated timeline for completion of this stage is late 2013.
Data systems and qualityCurrently, cervical screening registers operate in each state and territory. Registers, governed by state and territory legislation, keep a confidential record of Pap smear and related test results and assist in the collection of national data and the monitoring and evaluation of the NCSP. State and territory cervical screening registers were developed independently with differences in structure, coding and terminology, recall/reminder timeframes and protocols for follow up. Recent work has been undertaken to improve the consistency of the data and follow-up protocols.
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The AIHW annual Cervical Screening in Australia report monitors the NCSP nationally. State and territory cervical screening registers provide the data for this report in an aggregated format. In 2009 new monitoring indicators were developed, which will allow the impact of HPV vaccination on cervical abnormality rates to be monitored over time.
The current register system is recognised as being effective in terms of its ability to record cervical screening history and undertake recall and follow up functions. The Renewal provides an opportunity to explore an improved data collection and management system, including options for a real or virtual national register system.
The NCSP Quality Management Plan 1996-99 was developed to provide the context for national initiatives to promote and implement quality assurance throughout the screening pathway. This stage will provide the opportunity to develop a new quality management plan that will incorporate any changes to the current program.
The anticipated timeline for completion of this stage is early 2014.
Program acceptabilityAny changes to the screening pathway such as the screening age range, interval and primary screening test will need to be assessed for its acceptability to ensure participation rates are maintained or improved. In particular, the Renewal will need to identify strategies to improve participation among under-screened women in the program. Strategies may include consideration of social marketing and health promotion approaches, access to health services, cultural appropriateness of service models and specific proposals to engage under-screened subgroups.
The anticipated timeline for completion of this component is early 2014.
What has been achieved to date?
Partner Reference Group
Consultation WorkshopsFour Partner Reference Group workshops were held on 27 and 29 March 2012. These workshops provided NCSP partners with an opportunity to hear about the Renewal; and provide feedback on the existing NCSP and the Renewal directly to the Renewal Steering Committee.
- Agenda (Word 38 KB) | HTML
- Powerpoint Presentation (PDF 874 KB) | (HTML)
- Report on Partner Reference Group Consultation (Word 310 KB) | (HTML)
NewslettersRegular E-newsletters are distributed to inform Partners of the progress of the Renewal.
- May 2012 (HTML) | (PDF 238 KB)
- August 2012 (HTML) | (PDF 223 KB)
- October 2012 (HTML) | (PDF 207 KB)
- April 2013 (HTML) | (PDF 225 KB)
- June 2013 (HTML) | (PDF 512 KB)
- September 2013 HTML | (PDF 161 KB)
- November 2013 HTML | (PDF 130 KB)
- December 2013 HTML | (PDF 129 KB)
Decision Analytic Protocol (DAP)The first phase of the Renewal is being undertaken through the Medical Services Advisory Committee (MSAC) process for reviewing the evidence for the safety, effectiveness and cost-effectiveness of new medical technologies and procedures.
As part of the MSAC review process, a decision analytic protocol (DAP) has been developed to guide the comparative analysis of the evidence for cervical screening and the value for money assessment (economic evaluation). A consultation DAP was released for public comment in May 2012. The public comments were reviewed by MSACs Protocol Advisory Sub Committee before the DAP was finalised in September 2012.
This component is now complete and the Final DAP is available on the MSAC website. This table from the DAP summarises the cervical screening scenarios that will be compared with the current cervical screening program in the review of the evidence.
Public Consultation on the Draft Review of EvidenceThe draft review of the evidence for cervical screening was made available for public comment from 7 June to 4 July 2013. The release of the draft review was not an MSAC requirement, but the Renewal Steering Committee was genuinely interested in seeking input from stakeholders to assit with identifying any additional substantive literature, prior to it being considered by MSAC.
When will the Renewal be completed?The first meeting of the Renewal Steering Committee was held on 28 November 2011 and it is anticipated that the Renewal process will be completed mid 2014.
Contact UsIf you require additional information on the Renewal please email the Cervical Renewal Team, Department of Health.
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